老年俯卧位脊柱手术术中压力性损伤危险因素分析

Analysis of risk factors for pressure injury during prone spine surgery in elderly patients

中文关键词: 老年  俯卧位  脊柱手术  术中压力性损伤  危险因素

英文关键词: elderly  prone position  spinal surgery  intraoperative pressure injury  risk factor

中文摘要:

      目的 探讨老年俯卧位脊柱手术术中获得性压力性损伤(Intraoperatively acquired pressure injury,IAPI)的危险因素.方法 纳入复旦大学附属华山医院2023年1月—2024年2月200例老年俯卧位脊柱手术患者,均行全麻手术.记录IAPI发生情况,根据是否发生损伤设为IAPI组和无IAPI组.比较2组基础资料、围术期资料等;组间进行单因素分析,以单因素分析差异具有统计学意义的资料为自变量,以是否发生IAPI为因变量,进行Logistic回归分析.结果 200例患者42例发生IAPI,其中Ⅰ期36例,Ⅱ期6例;单因素分析显示,2组年龄、手术时间、出血量、合并糖尿病、营养不良、疾病类型、术前运用血管活性药物、麻醉分级差异均有统计学意义(P＜0.05),2组性别、体质量指数、麻醉方法、合并高血压、合并高血脂差异均无统计学意义(P＞0.05);Logistic回归分析显示,年龄＞75岁、手术时间＞3 h、合并糖尿病、营养不良、脊柱肿瘤、术前运用血管活性药物是老年俯卧位脊柱手术IAPI的危险因素(OR值2.045～3.211,P＜0.05).结论 老年患者俯卧位脊柱手术患者IAPI发生率较高,以Ⅰ期损伤为主,年龄大、手术时间长、合并糖尿病等会增加IAPI发生风险.

英文摘要:

      Objective To explore the risk factors for intraoperative acquired pressure injury(IAPI)during prone spine surgery in elderly patients.Methods 200 elderly patients receiving prone spine surgery in Huashan Hospital Affiliated to Fudan University from January 2023 to February 2024 were enrolled.All patients underwent general anesthesia.The occurrence of IAPI was recorded.They were divided into IAPI group and non-IAPI group according to whether IAPI occurred.The basic data and perioperative data of the two groups were compared.Univariate analysis was performed between groups.Logistic re-gression analysis was carried out with the data with statistical significance in univariate analysis as independent variables and the occurrence of IAPI as dependent variable.Results Among the 200 patients,42 ones developed IAPI,including 36 ones in stage Ⅰ and 6 ones in stage Ⅱ.Univariate analysis showed that there were statistically significant differences in age,operation time,blood loss,combined diabetes,malnutrition,disease type,preoperative use of vasoactive drugs and anesthesia grade be-tween the two groups(P＜0.05),but there were no statistically significant differences in gender,body mass index,anesthesia method,combined hypertension and combined hyperlipidemia between the two groups(P＞0.05).Logistic regression analysis showed that age＞75 years,operation time＞3 h,combined with diabetes,malnutrition,spinal tumor,and preoperative use of vasoactive drugs were the risk factors for IAPI in elderly patients undergoing prone spinal surgery(OR 2.045-3.211,P＜0.05).Conclusion The incidence of IAPI is higher in elderly patients undergoing prone spinal surgery,mainly with stage Ⅰinjury.Older age,long operation time,and combined diabetes will increase the risk of IAPI.